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T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab

Many adverse reactions associated with immune checkpoint inhibitor (ICI) treatments are immunologically driven and may necessitate discontinuation of the ICI. Herein, we present a patient who had been administered the radio contrast media amidotrizoate multiple times without issue but who then devel...

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Autores principales: Hammond, Sean, Olsson-Brown, Anna, Gardner, Joshua, Thomson, Paul, Ali, Serat-E, Jolly, Carol, Carr, Dan, Ressel, Lorenzo, Pirmohamed, Munir, Naisbitt, Dean
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166637/
https://www.ncbi.nlm.nih.gov/pubmed/34049931
http://dx.doi.org/10.1136/jitc-2021-002521
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author Hammond, Sean
Olsson-Brown, Anna
Gardner, Joshua
Thomson, Paul
Ali, Serat-E
Jolly, Carol
Carr, Dan
Ressel, Lorenzo
Pirmohamed, Munir
Naisbitt, Dean
author_facet Hammond, Sean
Olsson-Brown, Anna
Gardner, Joshua
Thomson, Paul
Ali, Serat-E
Jolly, Carol
Carr, Dan
Ressel, Lorenzo
Pirmohamed, Munir
Naisbitt, Dean
author_sort Hammond, Sean
collection PubMed
description Many adverse reactions associated with immune checkpoint inhibitor (ICI) treatments are immunologically driven and may necessitate discontinuation of the ICI. Herein, we present a patient who had been administered the radio contrast media amidotrizoate multiple times without issue but who then developed a Stevens-Johnson syndrome reaction after coadministration of atezolizumab. Causality was confirmed by a positive re-challenge with amidotrizoate and laboratory investigations that implicated T cells. Importantly, the introduction of atezolizumab appears to have altered the immunologic response to amidotrizoate in terms of the tolerance–elicitation continuum. Proof of concept studies demonstrated enhancement of recall responses to a surrogate antigen panel following in-vitro (healthy donors) and in-vivo (ICI patients) administrations of ICIs. Our findings highlight the importance of considering all concomitant medications in patients on ICIs who develop immune-mediated adverse reactions. In the event of some immune-related adverse reactions, it may be critical to identify the culprit antigen-forming entity that the ICIs have altered the perception of rather than simply attribute causality to the ICI itself in order to optimize both patient safety and treatment of malignancies.
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spelling pubmed-81666372021-06-17 T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab Hammond, Sean Olsson-Brown, Anna Gardner, Joshua Thomson, Paul Ali, Serat-E Jolly, Carol Carr, Dan Ressel, Lorenzo Pirmohamed, Munir Naisbitt, Dean J Immunother Cancer Case Report Many adverse reactions associated with immune checkpoint inhibitor (ICI) treatments are immunologically driven and may necessitate discontinuation of the ICI. Herein, we present a patient who had been administered the radio contrast media amidotrizoate multiple times without issue but who then developed a Stevens-Johnson syndrome reaction after coadministration of atezolizumab. Causality was confirmed by a positive re-challenge with amidotrizoate and laboratory investigations that implicated T cells. Importantly, the introduction of atezolizumab appears to have altered the immunologic response to amidotrizoate in terms of the tolerance–elicitation continuum. Proof of concept studies demonstrated enhancement of recall responses to a surrogate antigen panel following in-vitro (healthy donors) and in-vivo (ICI patients) administrations of ICIs. Our findings highlight the importance of considering all concomitant medications in patients on ICIs who develop immune-mediated adverse reactions. In the event of some immune-related adverse reactions, it may be critical to identify the culprit antigen-forming entity that the ICIs have altered the perception of rather than simply attribute causality to the ICI itself in order to optimize both patient safety and treatment of malignancies. BMJ Publishing Group 2021-05-28 /pmc/articles/PMC8166637/ /pubmed/34049931 http://dx.doi.org/10.1136/jitc-2021-002521 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See https://creativecommons.org/licenses/by/4.0/.
spellingShingle Case Report
Hammond, Sean
Olsson-Brown, Anna
Gardner, Joshua
Thomson, Paul
Ali, Serat-E
Jolly, Carol
Carr, Dan
Ressel, Lorenzo
Pirmohamed, Munir
Naisbitt, Dean
T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab
title T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab
title_full T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab
title_fullStr T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab
title_full_unstemmed T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab
title_short T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab
title_sort t cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166637/
https://www.ncbi.nlm.nih.gov/pubmed/34049931
http://dx.doi.org/10.1136/jitc-2021-002521
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